Obesity in the United States

Are you or a loved one trying to lose weight? You are not alone.
Obesity is a serious, chronic disease that affects 100 million Americans - which is 2 out of every 5 US adults 20 years of age and older. Of those, 22 million US adults have severe obesity.

What is the difference between obesity and severe obesity?
Obesity can be diagnosed by body mass index, abbreviated BMI. For most people, BMI is a reasonable estimate of body fat, calculated using height and weight. However, BMI may not be a good estimate for muscular athletes in which the BMI is elevated in the obesity range but do not have excess body fat. There are many BMI calculators online that can calculate one's BMI. The basic calculation is multiplying one's weight in pounds by 703, then dividing by one's height in inches, and then dividing by one's height in inches again.

General guidelines:
Weight status BMI
Obesity 30 - 39.9
Severe obesity 40 and higher

The concern is that obesity is a disease that can cause other health conditions such as heart disease, stroke, type 2 diabetes, certain cancers, gallbladder and liver problems, kidney problems, obstructive sleep apnea, and other severe respiratory illnesses. High blood pressure is diagnosed in 58% of obese patients and type 2 diabetes is diagnosed in 23% of obese patients. Obesity stresses the joints which can cause pain and osteoarthritis, limiting activities and mobility. The risk of these health conditions increases as the BMI increases.
Obesity may also negatively impact social well-being and mental health, causing anxiety and depression due to bias and poor body image. Additionally, obesity can cause a poor quality of life.

Why measure my waist circumference?
There are two types of fat distribution: subcutaneous and visceral. Subcutaneous fat is located just under the skin. Visceral fat lies within the abdomen and pads the spaces between the organs. Visceral fat is the most concerning type of weight gain because high amounts of visceral fat are linked with high blood pressure, high blood sugar levels, and high cholesterol levels, risk factors for heart disease. Weight-related health problems are more common in men with a waist circumference over 40 inches and in women with a waist circumference over 35 inches.

Why are so many Americans obese?
There is a common misconception that obesity is due to the lack of willpower to eat healthy and exercise more. On the contrary, obesity is not a simple problem of self-control but a complex disease with many causes and factors resulting in chronic, excessive accumulation of body-fat caused by long-term disorders of energy metabolism and appetite regulation. Just a few examples of these include: slowed metabolism with age, lean muscle mass steadily declining with age, genetics, medication side effects, poor sleep, hormonal imbalances, gut microbiome, stress, access to affordable healthy food options, safe place to exercise, access to health care, and health conditions limiting physical ability to be active.
Obesity in the US increased from 30.5% in 2000 to approximately 42% in 2020. One cause of this is the COVID-19 pandemic that impacted many Americans, affecting physical activity and eating habits. Another cause is that American culture promotes inactivity through many modern technologies, enabling Americans to work at home remotely, shop online, and be entertained on devices from the luxury of their home. Additionally, the American diet includes high-caloric beverages such as soft drinks and alcohol and fast food lacking in fruits and vegetables.

Why is losing weight so difficult?
Although the basic formula for weight loss is to burn more calories than one consumes, the process is more complicated than that.
One reason is because of the multitude of causes and factors that lead to becoming obese.
Therefore, the treatment for losing weight is not simple or straightforward for most patients.
There is not one specific treatment for all obese patients.
Another reason is that the human body is very complex. However, its goal is to stay in homeostasis for survival. Homeostasis is the body's ability to self-regulate to maintain a stable and balanced internal environment despite external changes. Suppose a patient attempts to lose weight by decreasing their caloric intake too much or too quickly. In that case, the body detects this as concern for food shortage and starvation. So, the body enters a "survival mode" by storing extra calories as fat, and the patient will not lose weight. Therefore, to maintain a stable and balanced internal environment, a reasonable weight loss goal is to lose approximately 1 pound per week, which means:
● decreasing your calorie consumption by 500 calories daily or
● increasing your activity to burn 500 calories per day
● or decreasing your calorie intake by 250 calories daily and increasing your activity to burn 250 calories per day
The good news is that even the smallest amount of weight loss decreases your risk factors for the health conditions that can develop from obesity.

How can patients begin to lose weight?
The first action is to find your reason(s) to lose weight and determine your inner drive that will continue to motivate you during weight gain and plateaus. Know that you are not alone when 2 out of 5 Americans are obese. Find your support system. Consult with your healthcare provider to begin a safe weight loss plan that considers one's medical conditions, medications, and physical ability to exercise. Consultation with a nutritionist and/or dietician may be invaluable to review current dietary habits and suggest minor changes that could make a big impact in decreasing caloric intake. Discussion of other healthy food options may also be encouraging for patients. Lifestyle modification is often a first-line treatment of obesity.

What are options that can help patients lose weight?
FDA prescription medications and even bariatric surgery options are available for some patients who meet specific criteria. However, both have financial costs and risks of side effects and complications. To overcome these limitations, some patients consider treatment options within Complementary and Alternative Medicine, including Acupuncture.

What is the data for Acupuncture treating obesity?
Although the number of clinical studies is limited, the following abstract is an analysis of 11 randomized controlled trials with a total of 338 participants in the acupuncture group and 305 participants in the sham acupuncture group. (Sham acupuncture is a procedure that is intended to be a placebo in which the patient believes they are receiving true Acupuncture, but the needles do not penetrate the skin or the needles are not placed in the appropriate location for therapeutic benefit.) The results of the analysis showed that auricular and electro acupuncture reduced BMI and waist circumference in obese patients.
https://pubmed.ncbi.nlm.nih.gov/28689171/
Zhang, R. Q., Tan, J., Li, F. Y., Ma, Y. H., Han, L. X., & Yang, X. L. (2017). Acupuncture for the treatment of obesity in adults: a systematic review and meta-analysis. Postgraduate medical journal, 93(1106), 743–751.
How does Acupuncture treat obesity?
"It is well-established that the hypothalamus plays a pivotal role in the regulation of food intake and energy homeostasis." The following review "briefly introduces these mechanisms of hypothalamic neural circuits underlying appetite and energy homeostasis, and probes potential targets for the treatment of obesity" with Acupuncture.
Mechanism of Action of Acupuncture in Obesity: A Perspective From the Hypothalamus - PMC
Wang L, Yu CC, Li J, Tian Q, Du YJ. Mechanism of Action of Acupuncture in Obesity: A Perspective From the Hypothalamus. Front Endocrinol (Lausanne). 2021 Apr 2;12:632324. doi: 10.3389/fendo.2021.632324. PMID: 33868169; PMCID: PMC8050351.

Just as different causes and factors contribute to patients' developing obesity, different treatment options and approaches will be needed for obese patients. Discussing with your healthcare provider is a priority when starting on one's journey to weight loss. Every small amount of weight loss positively impacts reducing the risk factors for the serious health conditions associated with obesity.